Student Information CHILD 1 Last Name First Name Hebrew Name Gender Male Female Date of Birth School Grade Grade Entering PreK K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Previous Jewish education? Yes No If Yes please describe Medical Information - Any Medical Challenges? Yes No If Yes please explain CHILD 2 Last Name First Name Hebrew Name Gender Male Female Date of Birth School Grade Grade Entering PreK K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Previous Jewish education? Yes No If Yes please describe Medical Information - Any Medical Challenges? Yes No If Yes please explain CHILD 3 Last Name First Name Hebrew Name Gender Male Female Date of Birth School Grade Grade Entering PreK K Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Grade 6 Grade 7 Grade 8 Previous Jewish education? Yes No If Yes please describe Medical Information - Any Medical Challenges? Yes No If Yes please explain Parent Information Father Title/First Name Dr. Mr. Last Name Work Phone Cell Phone Occupation Email Mother Title/First Name Mrs. Dr. Ms. Last Name Work Phone Cell Phone Occupation Email Parents Address City/State/ Zip Home Phone Affiliation Have there been any adoptions or conversions in the family (e.g., the child, parents, grandparents) Yes No If yes, please explain and indicate which synagogue the conversion took place Emergency Information Emergency 1 Name Phone # Relation Emergency 2 Name Phone # Relation Tuition Fees Please contact Miriam Ferris at (510) 684-5292, to discuss any issues or concerns. In person classes are held at Chabad Berkeley Jewish Center - For Online Zoom Class contact us for more info Tuition: $650 5% Discount for a friend referral | Friend's Name Payment Information Please Choose Payment Plan - Select Plan - Pay in Full Two Payments For Check Payments: Please mail to Chabad Berkeley Hebrew School: P.O. Box 5292 Berkeley, CA 94705 I would like to assist a child who cannot afford Hebrew School Education. - Select Amount - $18.00 $36.00 $72.00 $180.00 $360.00 $550.00 $650.00 $700.00 Signature I heard about the Chabad Hebrew School from Digital Signature Please click "submit" below to complete registration. Online Payment will still be necessary to complete enrollment. This page uses 128 bit SSL encryption to keep your data secure.
